Transitive Learning and Use In Nursing Education
Why Simulators are Used In Transitive Learning
Simulation involves the use of human like manikins, or human patient simulators (HPS), ranging from low fidelity to high fidelity. High fidelity refers to the most technologically advanced versions, which mimic many human physiological reactions to trauma, illness, and interventions. The manikin is designed to look human and to respond in a human-like manner. The responses are controlled by an instructor or facilitator via a computer, which enables the direction of scenarios that mimic illness and trauma.
Nursing students are able to practice nursing interventions, such as medication administration, after assessing changes in health in the HPS. The facilitator can then replicate physiological changes in health status and acuity in response to the student's interventions as required for the clinical scenario. Often the HPS is placed in a room designed to mimic a clinical environment to realistically simulate a nursing practice experience.
Benefits of Simulators In Nursing Education
Depending on the desired learning outcomes and pedagogical structures that underpin a simulation based clinical curriculum, dominant learning theories must be considered to facilitate high-fidelity simulated learning sessions. Depending on whether the goal is the red learning of factual knowledge and psycho-motor skills or, conversely, the enhancement of problem solving, nursing educators should consider the application of theory in designing HPS based clinical scenarios. Guidelines for behaviorist-based simulation include the incorporation of low levels of acuity and complexity to avoid overwhelming adult learners, the repetition of learning experiences, theory supplementation, and the incorporation of modular learning.
Guidelines for constructive based simulation include access to a variety of information resources in the simulation laboratory; the negotiation of learning objectives between the instructor and the students; and the creation of scenarios that involve uncertainty, increased acuity, and amplified environmental noise. To guide the educator on which form of pedagogy to apply, it is pertinent also to consider the role that social discourse and transformative learning theory play in a simulation-based learning environment HPS-based clinical scenarios are in reality social endeavors that lead to the collaborative creation of knowledge (Parker & Myrick. 2012).
Therefore, social discourse and perspective transformation in Mezirow's (1994, 1995) transformative learning theory should come to the forefront. HPS based clinical scenarios, with the use of group process, peer filtering of knowledge, and critical reflection, are well suited for contributing to transformation of the student's meaning schemes and perspectives. HPS based clinical scenarios are also useful in delivering disorienting dilemmas that upset learners' knowledge and understanding of health care and skill application, Upsetting perceived knowledge.
Values, and beliefs about clinical practice through exposure to high fidelity simulation helps students learn to reinterpret a dilemma and ultimately incorporate new meanings into their cognitive schema. Similarly to con structuralist pedagogy, transformative learning theory empowers students to define goals, make choices, and solve problem. Furthermore, the instructor can model experimental engagement and encourage regular, noncompetitive feedback (Mezirow, 1991).Other strategies specific to HPS that might be considered include repeating HPS scenario sessions, increasing students' exposure to HP5 to foster the development of trusting relationships, and using video play back to promote critical reflectivity.
Nurse educators should also consider using incremental mental disorientating dilemmas for more junior learners instead of exposing them to emotionally charged experiences to avoid overwhelming and hindering their ability to cognitively process the scenario. For many students, especially more novice learners, there appears to be a significant potential for self-esteem and confidence in their clinical knowledge and skills to be threatened in a high fidelity simulated clinical session.
Further recommendations to counter these potential threats include gradually increasing peer observation, assessing the overuse of signal and noise, increasing or decreasing the simulation facilitator's direct interference of support during a clinical scenario, leveling acuity and interpersonal conflict to the level of the student, maintaining role authenticity, and providing students with the tools necessary to become oriented to the simulation environment
Outcomes and Research On Simulators Use
The current body of research has shown evidence from students and educators of perceived efficacy in simulation (Mould, White, & Gallagher, 2011; Smith Stoner & Hand, 2008); perceived confidence building (Fisher & King, 2013); and moderate evidence of improved skill performance and/or retention (Cant & Cooper, 2010; LevettJones, Lapkin, Hoffman, Arthur, & Roche, 2011). Unfortunately, the current state of knowledge has specific limitations, including an overemphasis on the simple description of a phenomenon (Rourke., Schmidt, Garga, 2010).
However, external validity is lacking as a result of informal evaluation methods and problems with rigor (Harder, 2010). Although the external validity may be questionable, the current body of research broadly endorses simulation as a valid educational practice.More specific endorsement of HPS based nursing education can be seen in relation to the application of transformative learning theory In particular, HPS enhances social dialogue and, subsequently, peer-validated socially derived knowledge (Leigh & Hurst, 2008; Parker & Myrick, 2010 ).
Although HPS based clinical scenarios have the potential to transform students' meaning schemes with regard to clinical practice and knowledge, they also have the potential to overwhelm the cognitive capacity and cause feelings of anxiety, stress, fear, and disengagement (Parker & Myrick, 2012). To this end, Dunnington (2014) recommended avoiding simple instrumental utilization of high-fidelity HPS, considering context and engaging learners in clinical scenarios.
The proliferation of HPSs in undergraduate nursing education raises questions about the application of well informed pedagogical practices. Despite a growing body of research into this technology-based learning tool, there is insufficient evidence on which to base decisions on best practice to both structure simulation based curriculum and facilitate HPS based clinical scenarios that meet the learning needs of the modern adult learners (Cant & Cooper, 2010; Rourke et al. 2010).
Although HPS based clinical scenarios facilitate group process and social construction of knowledge (Leigh & Hurst, 2008; Parker & Myrick, 2010), there has been limited research into these social processes. Fisher and King (2013) noted that further research is needed in the areas of simulation and inter-professional collaboration as it relates to health care education.
Ultimately, there is a need to move beyond the hypothetical deductive approach and build a theoretical framework based on the processes that occur in high fidelity simulation. This movement will also foster future research that more accurately reflects the complex social processes that those who participate in HPS based clinical scenarios experience. Uncovering the social processes that occur with the HPS based simulated clinical learning environment will assist nursing educators in developing simulation based curricula that are truly transformative learning for the modern adult learner.
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